Dailey S M, Kay G N, Epstein A E, Plumb V J
Division of Cardiovascular Disease, University of Alabama, Birmingham 35294.
Pacing Clin Electrophysiol. 1992 Nov;15(11 Pt 1):1646-50. doi: 10.1111/j.1540-8159.1992.tb02949.x.
Antiarrhythmic drugs have no consistent effects on the signal-averaged electrocardiogram (ECG) while successful surgical ablation of ventricular tachycardia is known to abolish late potentials. Ten patients with prior myocardial infarction had successful ablation of recurrent sustained ventricular tachycardia by selective ethanol infusion into a small coronary vessel supplying the tachycardia origin. Signal-averaged ECGs were performed before and after initially successful ablation in patients without pacemaker dependence or intraventricular conduction delay to assess the effects on late potentials and to determine if the signal-averaged ECG could predict ventricular tachycardia recurrence. Only four of ten patients were eligible for study and all four had late potentials prior to ethanol ablation. Late potentials were abolished in one patient who has not had an arrhythmia recurrence in 25 months. One patient with sudden death and another patient with ventricular tachycardia recurrence had persistent late potentials post procedure that were modified by a reduction in terminal voltage and lengthening of terminal low amplitude signal. The fourth patient who receives chronic amiodarone had no arrhythmia recurrence in spite of persistent but modified late potentials. Thus, the abolition of late potentials after ethanol ablation may predict freedom from arrhythmia recurrence.
抗心律失常药物对信号平均心电图（ECG）没有一致的影响，而已知成功的室性心动过速手术消融可消除晚电位。10例既往有心肌梗死的患者通过向供应心动过速起源部位的小冠状动脉选择性注入乙醇，成功消融了复发性持续性室性心动过速。在最初成功消融前后，对无起搏器依赖或室内传导延迟的患者进行信号平均心电图检查，以评估对晚电位的影响，并确定信号平均心电图是否能预测室性心动过速复发。10例患者中只有4例符合研究条件，且这4例在乙醇消融前均有晚电位。1例患者在25个月内未出现心律失常复发，其晚电位已消除。1例猝死患者和另1例室性心动过速复发患者术后仍有持续性晚电位，通过降低终末电压和延长终末低幅信号使其有所改变。第4例接受慢性胺碘酮治疗的患者尽管仍有持续性但已改变的晚电位，但未出现心律失常复发。因此，乙醇消融后晚电位的消除可能预示着无心律失常复发。
